Kelly Ross Goodwin

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L6491 Issued in OR

Practice address

916 SW 17TH St Ste 202
Redmond, OR 97756-2572

Phone

(541) 706-2768

NPI assigned

Sep 21, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Charles Health System IncGroup PAC ID 3870402852, 174 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgoodwin14824@secure.stcharleshealthcare.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Charles Health System, Inc.

  • General Acute Care Hospital
  • Bend, OR
  • NPI 1982621447
  Medicare reassignment Care Compare group NPD
• St. Charles Health System, Inc.

  • Rehabilitation Hospital Unit
  • Bend, OR
  • NPI 1154343150
  NPD
• St. Charles Health System, Inc.

  • Critical Access Hospital
  • Madras, OR
  • NPI 1356389894
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1467068999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016015",
            "telephone_number": "541-382-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 SW 17TH ST STE 202",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977562572",
            "telephone_number": "541-706-2768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "KELLY",
        "middle_name": "ROSS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-21",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": "6491",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgoodwin14824@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "916 SW 17th St Ste 202",
            "city": "Redmond",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977562572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kelly Gobler, COTA/L
• Jeffrey Michael Gonzales, FNP C
• Laurie Gonzales, RPH
• Patricia Gonzalez
• Goodwin Counseling & Wellness LLC
• Melissa Goray
• Ryan Robert Gorman
• Lori Ann Gorton
• Mary Kathleen Grady, DDS
• Courtney Graham, LCSW

• Clinical Social Worker in Redmond, OR
• Providers in Redmond, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.